Hiv Infection Of The Brain

There were reports of neuropsychiatry complications in AIDS even before HIV was determined to be the cause of the disease. Brain autopsies of persons dying with AIDS revealed a number of changes beyond those attributable to opportunistic infections or neoplasms. These HIV-related brain changes include

budding virus released

Figure 1 (continued)

budding virus released

Figure 1 (continued)

inflammation, white matter abnormalities (vacuolar myelopathy), and nerve cell loss (poliodystrophy). The inflammatory process can be evidenced by perivascu-lar lymphocytic infiltrates, accumulations of microglia into nodules, formation of multinucleated giant cells, as well as astrogliosis (Fig. 2).

Most persons dying with HIV infection have some detectable HIV in the brain. Although HIV can be found in any brain region, the greatest concentration of virus tends to be in subcortical gray structures (e.g., caudate nucleus) and surrounding white matter. HIV is localized within microglia and multinucleated giant cells but is not found in neurons. Despite this, the neurons of persons dying with HIV often display injury consisting of dendritic simplification and loss of synapses (Fig. 3). This has led to speculation that neural damage, and ultimately neuronal loss, may represent some combination of toxic factors and

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